Tungiasis Presenting as Onychomycosis: Probably the First Report of Flea Infestation of the Nail Observed Using Modified Potassium Hydroxide Mount Technique.

Tungiasis is an infection/infestation of the flea Tunga penetrans. These are bloodsucking ectoparasitic insects belonging to the phylum Arthropoda, and they do not possess wings, but they have long legs enabling them to jump up to 30 cm high. The fleas are usually present on the skin and in the hair of domestic and wild animals and are prevalent throughout the world. They may also be present in an environment consisting of dry sandy soils, and they infect people who walk barefoot and reside in flea-infested areas. Human tungiasis is both an accidental and zoonotic infection, where the fleas enter the human skin and cause severe morbidity if not properly managed. There are a few reports of human tungiasis, most of which were diagnosed with skin infections. This is a first-of-its-kind observation of fleas in the nail, from a patient who is suspected to be suffering from onychomycosis. The nail in this case was processed differently, by using a modified potassium hydroxide (KOH) mount technique.